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CC BY-NC-ND 4.0 · Journal of Clinical Interventional Radiology ISVIR 2022; 06(03): 170-176
DOI: 10.1055/s-0041-1740459
Original Article

Pharmacomechanical Thrombectomy for Acute Limb Threatening Lower Extremity Arterial Thrombosis Secondary to COVID-19

Rajesh Girdhardas Mundhada
1   Pulse Clinic and Hospital, Nagpur, Maharashtra, India
,
Atul Dharmaraj Rewatkar
1   Pulse Clinic and Hospital, Nagpur, Maharashtra, India
,
Anju Rajesh Mundhada
1   Pulse Clinic and Hospital, Nagpur, Maharashtra, India
,
Aishwarya Atul Rewatkar
1   Pulse Clinic and Hospital, Nagpur, Maharashtra, India
,
Nikita Navin Chandak
2   Final Year Medical Student, King Edward Medical College, Mumbai, Maharashtra, India
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Abstract

Purpose The aim of this study was to report the clinical effectiveness and safety of pharmacomechanical thrombectomy (PMT) for acute limb threatening lower extremity arterial thrombosis secondary to coronavirus disease 2019 (COVID-19).

Methods In this retrospective study, the clinical and imaging records of six patients (6 men, mean age 56 years) with COVID-19-related lower extremity arterial thrombosis and treated with PMT using the Angio-Jet device were reviewed. Patients presented with symptoms of acute pain in the affected limb, pallor, pulselessness, paresthesia, or paralysis. Thrombosis involved below knee arteries in all patients, and above knee arteries in three patients. Reteplase 18 mg was infused into the thrombus using the power pulse mode on the Angio-Jet device. This was followed by rheolytic thrombectomy and then, intra-arterial infusion of urokinase 100,000 IU/hour for 5 hours. All patients received systemic intravenous heparin. Technical success, clinical success, and complications of PMT were analyzed.

Results The mean thrombectomy duration was 190.83 ± 99.18 seconds. Adjuvant balloon angioplasty was performed in two patients. The mean hospital stay was 7.67 ± 4.50 days. PMT was technically successful in all (100%) patients. Five patients had excellent clinical outcome with at least one palpable pulse and no tissue loss. One patient required minor amputation. One patient developed self-limiting retroperitoneal hematoma.

Conclusion In our series, PMT with supplemental intra-arterial urokinase infusion was highly successful in treating acute peripheral arterial thrombosis secondary to COVID-19.

Keywords

COVID-19-related arterial thrombosis - Angio-Jet thrombectomy system

Ethical statement

This is a retrospective, institutional review board approved study.




Publication History

Article published online:
17 January 2022

© 2022. Indian Society of Vascular and Interventional Radiology. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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